On-Line Application Form for Summer Programs
Student Information
Last Name:
First Name:
Male Female
Date of Birth (DD/MM/YY):
Home Address (Number & Street):
Apt/Unit #:
City and Province/State:
Country:
Postal Code:
Home Phone:
e-mail:
Have you or one of your siblings joined us in the past? Yes No
Special Needs
Dietary Needs:
Do you have a medical history or use any medications of which we should be informed:
yes no
If yes please explain:
Please identify any special education needs:
Academic Information
Present School:
School Board:
School Address:
Phone #:
Counsellor/Advisor:
Course Selection
Please select Month of Departure Preferred July August
Please select Program choice and course(s)
Greece & Italy One Credit Program Two Credit Program
1st Credit
2nd Credit
Classical Civilization, Grade 12, LVV4U
Philosophy: Questions And Theories, Grade 12, HZT4U
Math, Advanced Functions, Grade 12, MHF4U
English, Grade 12, ENG4U
Introduction to Anthropology, Psychology, & Sociology,
Grade 11, HSP3M
Italy & The Islands of Malta One Credit Program Two Credit Program
New Zealand & Australia
England, Scotland & Ireland
Paris & The South of France
Europe and the Arts
Ecuador & Peru
Southeast Asia - Bali, Cambodia, Vietnam
China
Costa Rica
Bermuda
The Grand Tour
Islands of Greece
Ancient Civilizations
Maya 2012 Adventure
Grade 10 in Tuscany
Grade 10 in Costa Rica
Grade 10 in Paris
Grade 10 in Oxford
Please indicate second choice:
Location:
Course:
I would like to room/class with
(if applicable and possible)
Parent/Guardian Information
Parent Salutation: Dr. Mrs. Ms. Mr. Last Name: First Name: Same address as child Home Address: Phone#: Business#: Mobile#: email: Fax:#:
Name of legal guardian if applicable:
PAYMENT
Comprehensive Travel Insurance (optional but strongly recommended) $195 Bermuda/Cost Rica Online programs $295 All other programs I will purchase the travel insurance
yes
no
Once you submit your application, a Payment Form will appear which you must complete and
forward to our office within 5 business days to reserve your space in the program.
A staff member will contact you to acknowledge receipt of your application and payment and to confirm space.
The deposit amount due is $1590 (if you have requested Insurance) or $1295 (if you have declined insurance)
and this amount will be deducted from your total balance.
You have the option to pay by VISA, MasterCard or by Cheque and the Payment Form can be faxed, emailed or mailed to our office.
I would like to receive an invoice by:
Email FAX Post
I have read the Terms and Conditions and agree to these terms and conditions.
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